Can fractional CO2 laser actually cause hypopigmentation?

Question

I’m asking because I’m reading very conflicting opinions online. Some say it’s a very rare risk while others claim it does not ever happen. I found only one article on Google Scholar stating it as a side effect but was completely reversible. I already had one procedure but I’m scheduled to have five more and I’m concerned.

Shanthala Shivananjappa, MD · Answer

This is an excellent question, and the short answer is yes—there is a risk of hypopigmentation (loss of skin pigment) or even hyperpigmentation (excess pigmentation) following fractional CO2 laser treatments. These risks are well-documented and can affect anyone, but the likelihood is significantly higher in certain skin types, particularly darker skin tones or individuals with underlying skin conditions.

It’s important to note that despite what you may read online, these risks are real and should not be overlooked. However, advancements in laser technology have significantly improved safety profiles. For example, innovative fractional ablative lasers like the UltraClear & Laser-Coring have greatly minimized the risks of both hypopigmentation and hyperpigmentation compared to traditional CO2 lasers. While there are no direct head-to-head comparison studies, anecdotal evidence and clinical experience suggest that the Ultraclear Laser offers a safer alternative with reduced downtime and improved results, especially for patients concerned about pigmentary changes.

Ultimately, the key to minimizing risks lies in working with an experienced physician who can tailor treatments to your unique skin type and needs, while using the latest technologies available.

Thank you for asking such an insightful question! I encourage you to consult with an expert to learn more about which laser treatment might be best for your skin.

Warm regards,
Dr. Shanthala

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser can cause hypo and hyperpigmentation so it should be performed by an experienced plastic surgeon. We are specialists in fractional CO2 and the sapphire combination lift with co2 and TCA.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Vincent Gardner, MD · Answer

Yes, fractional CO2 can cause pigmentation issues. It is much less likely than full field CO2. Fractionated by definition means only a fraction of the skin is treated therefore, pigmentation and scarring are much less of a concern. It really depends on how deep the practitioner is treating as well as other parameters such as the percentage of surface area and the amount of heat that is applied. These are variables that can be adjusted on the laser. A CO2 that is done in the OR with local blocks and sedation is typically a much more aggressive treatment. A series of treatments that are done in the med spa with local numbing only will not typically be as aggressive, thus increasing the number of treatments needed. if the melanocytes are damaged due to heat and depth of treatment, this can lead to issues with pigmentation. Risk of scarring and pigmentation issues with a “Medspa” fractionated CO2 would be very low. I hope this helps. Good luck!

Laura Ellis, MD · Answer

Hypopigmentation is a lightening of the normal skin color. It can occur for many reasons and can be permanent. When seen after laser skin resurfacing, it is typically due to damage to the melanocytes (pigment producing cells) which do not grow back. Fully ablative CO2 laser skin resurfacing of the face in the 1990's commonly caused hypopigmentation that left an obvious line of demarcation along the jawline. I published an article in the medical literature in 1996 describing this complication. It is because of this complication and others that led to the "fractionation" of laser beams now employed in modern lasers. So these days, it is very uncommon to see true hypopigmentation with Fractional Laser Resurfacing. However, it can still occur especially in cases in which too much energy was applied or too many passes were performed.
CO2 Laser Resurfacing: Recognizing and Minimizing Complications, Roberts, T.L., Lettieri, J.T., Ellis, L.B., Aesthetic Surgery Quarterly, 2:16, 142-8. 1996

Can fractional CO2 laser actually cause hypopigmentation?

Answers (4)

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